1

Poole

Drug Action Team

Adult drug treatment plan 2004/05

Part 1: Strategic summary

This strategic summary and attached planning grids have been approved by the DAT and are submitted as our collective action plan responding to the needs of people with substance misuse problems in the DAT area.
Signature	Signature
Chair, NAME DAT (on behalf of the Partnership)	Chair, Joint Commissioning Group

1 Strategic summary

1.1 Describe your understanding of the problem drug situation in your DAT area. (Max. 150 words)

An increasing number of clients accessing Poole Addictions Community Team are presenting as chaotic polydrug users. Many are using a range of illicit substances simultaneously in a dangerous and sometimes life threatening and disordered way. The client group is often involved with a number of professionals from criminal justice, health and voluntary organisations and many have failed a number of treatment modalities in the community. There is a noticeable increase in clients presenting with dual heroin/crack use. Current referrals to Poole Addictions Community Team are approximately 65% male;35% female with 98% of referrals being White British. Please see 2.1 for numbers in treatment.

The integrated CJIP team has identified that a significant proportion of those seen in the custody suite and identified as having a substance misuse problem, are not willing to engage with treatment services. From the total number of those arrested approximately 50% are referred to the arrest referral worker. Of those referred, nearly half are from out of area (and are referred to ARS workers for their area of residence) and from those seen, 15.5% engage in tier 2 services and 19% are referred to tier 3 with 11% engaging in treatment. These figures provide an indication that approximately 50% of problem drug users in Poole access treatment services. It should be noted that there is a higher percentage of males than females in the criminal Justice system although the breakdown by ethnicity remains at a similar level to the specialist service.

In recognition that not all users are prepared to access treatment, there is a need for improved harm minimisation services to include testing and, where appropriate, immunisation for blood borne viruses.

With regard to the young people’s specialist service, there has been a noticeable increase in referrals from young people identifying problems relating to cannabis use. CAHMS has also identified an increase in young people presenting with cannabis related psychosis.

1.2 What will the DAT commission in 2004/5 and beyond to meet these needs?

The Drug Action Team recognises that much of its planning is ‘demand led’ rather than ‘needs led,’ due to the difficulty of accurately identifying local need. In recognition that more robust information is needed to enable effective development of service provision the Drug Action Team will seek to establish a local evidence base as part of its forthcoming drugs audit. Partners from the DAT and CDRP have been requested to consider how to more accurately identify need in relation to both their own service provision and the wider community and it is envisaged that the new merged partnership will also provide opportunities to develop this work.

The Drug Action Team will continue to commission the Poole Addictions Community Team to provide a locality based specialist service and will work with the provider to develop and extend the range of treatment available. Provision will include stimulant clinic, group work, women’s only clinic, arrest referral, prison liaison, complementary therapies, outreach work, community detoxification, and access to structured day care, counselling, inpatient detox and residential treatment. The service also includes a specialist worker to meet the needs of children (under 10) of substance misusing parents and provides priority access/support for clients in ‘dry’ accommodation. NB It should be noted that the range and extent of the service provided will be conditional on mainstream funding being made available to enable the Drug Action Team to commission effective provision. Currently the majority of services are funded by the Pooled Treatment Budget which is allocated on ‘zero growth’ for 2004/05. Without the benefit of mainstream funding the Drug Action Team will be faced with making cuts in services. Although the addictions service has already met its targets (from the baseline figure) for the PSA over its full term the DAT has made it clear that without the benefit of mainstream funding it will not be possible to maintain the current service provision nor expand service provision to meet the need for additional treatment places.

Changes to services commissioned through Dorset Healthcare NHS Trust will, for the first time, provide priority beds for Poole clients needing inpatient detox. This will reduce the burden on the residential budget and provide increased access to stabilisation prior to detox. This was not been available to Poole clients prior to April 2004. More effective use of this provision should reduce the burden on the residential budget. Monitoring of the use of this provision will continue during 2004 and if full use is not made by Poole Addictions Community Team, the Drug Action Team will have the opportunity to allow other DATs to ‘purchase’ beds which would provide additional income to commission alternative treatment options. As this will be the first year that Poole has had the benefit of priority beds it is difficult to predict need/demand. This will be closely monitored to enable more accurate planning in future years. NB As a matter of great concern it should be noted that, since the submission of the draft Plan, DHCT are suggesting that the Inpatient Unit will need to close unless the three Dorset Drug Action Team’s are able to considerable additional funding

New premises for Poole Addictions Community Team will for the first time provide the opportunity for a dedicated harm minimisation service to be established. A daily specialist needle exchange will be provided and access to a blood borne virus service will be a priority. It is hoped that a local funding arrangement will be reached with GPs to facilitate patient referrals for Hep B immunisation through Poole Addictions Community Team. In partnership with Bournemouth and Dorset Drug Action Team’s, a new community pharmacy needle exchange provision will be commissioned which will also deliver harm minimisation and general health information and provide a link with the specialist service.

In recognition of the holistic needs of clients, an enhanced throughcare/aftercare project will be commissioned to meet the needs of those in the Criminal Justice System

As part of Models of Care implementation, the Drug Action Team will ensure that the Service User Forum will work with the Specialist Service to provide and effective care co-ordination role for clients. Proposals for developing this work are in discussion

Currently no GP’s are involved in Shared care within the DAT area. Considerable work is taking place with the PCT to engage GPs as part of the new contracts. The target for this year is 5 practices, rising to 6 next year, thereby meeting the 30% target. Although the figure quoted for GP treatment places is low, it is hoped that the DAT can exceed predicted numbers over a 2 year period as Shared Care is developed.

The Drug Action Team is required to increase the number of DTTO commencements from its zero growth budget. It will therefore be necessary to work with the Probation Services to provide alternative ‘low intensity’ provision to ensure additional treatment places are available from within existing funding levels.

A dedicated, multi agency integrated young people’s service has been established to meet the needs of young people from Poole and Bournemouth. The Drug Action Team will continue to jointly commission this service in partnership with Bournemouth Drug Action Team

1.3 What progress has been made to date?

New service Specifications have been prepared for DHCT and implementation is planned and on schedule for the new financial year. Agreement will be sought for a stepped implementation by September 2004. As part of the process the Drug Action Team will work with S&E Dorset PCT towards a formal Section 31 Agreement to allow greater freedom and flexibility to deliver against the modernisation agenda.

Joint pan Dorset work is progressing Models of Care implementation. The Poole Treatment Sub Group has taken responsibility for overseeing developments and the new substance misuse directory, which includes referral routes, is due to be published early in the new year. A review of progress in underway and a revised action plan will be agreed.

The new throughcare/aftercare project is being developed to include an ‘out of hours’ provision and close working arrangements with Poole Addictions Community Team. All CJIP clients will be assessed through PACT as part of a fully integrated team approach and a new dedicated support service will be available at weekends. There will be a positive impact on waiting times as the new provision will engage clients throughout their time in the CJS and into appropriate treatment/throughcare upon release (Fully developed proposal has been approved by GO DT)

New requirements on the Drug Action Team to collect data on behalf of the PCT in line with the minimum data set has led to the creation of a new electronic data collection system for providers. This is work in progress which will be developed further as part of Models of Care. The new system will be refined to enable tracking of clients in and between treatment modalities and to provide information to inform returns in relation to NTA targets, new DAT KPI’s, BVPI’s and LPSA targets.

In the short term, the MoC care co-ordination role will be undertaken ‘in house’ pending the outcome of discussions with providers in relation to a more effective provision. Funding will also need to be identified as a result of a formal Section 31 Agreement.

In consultation with Bournemouth Drug Action Team and Probation, proposals for joint funding of an alternative low intensity DTTO provision are being progressed. The treatment option would include links to the new CJIP aftercare project.

The young people’s treatment service has developed over 18 months from a number of different funding streams and, as a result of inadequate financial resources and ‘one off’ funding it has grown without an adequate management/administrative structure to support the service. The increase in the number of referrals has demonstrated the need for the service and the Drug Action Team is committed to provide a robust and effective structure through the provision of consistent funding which allows effective planning of future services.

One area in which the Drug Action Team consistently fails to meet targets, is the engagement of GP’s in Shared Care. To address this, the Drug Action Team, PCT and Poole Addictions Community Team are working to support practices to deliver this service. It is neither appropriate nor practical to expect every practice to provide an enhanced service under the new GP contract but a local target of engagement with 6 practices has been established

Links have been made with the Mental Health LIT to identify local need on relation to Dual Diagnosis and work will continue over the coming year to develop local service provision.

1.4 What are the DAT’s top treatment priorities for 2004/05?

Extend the range of treatment options available through Poole Addictions Community Team and ensure access within national waiting time targets. Particular attention will be given to meeting the needs of clients presenting with cocaine/crack use as either their primary or secondary drug of choice.

As a result of the new Service Specifications, provide access to priority beds within the local inpatient detoxification unit for both stabilisation and detox.

Monitor changes to DHCT service provision to ensure compliance with new service specifications. This will include monitoring a varied range (according to need) of prescribing options in addition to methadone.

Undertake a pilot project to provide ‘drug free’ detoxification and monitor and evaluate to provide comparable data with medicated detoxification.

Engage 5 GP practices in shared care services as part of the ‘National Enhanced Services’ available through the new GP contracts.

Work with the PCT on a range of clinical governance issues including high prescribing, prescribing of therapeutic doses and benzodiazepine prescribing regimes. The Drug Action Team will also seek to ensure that all providers have critical incident policies and that monitoring of practice and procedures is reported regularly to the Drug Action Team JCG.

2. Building treatment capacity

The national target is to increase the participation of problem drug users in drug treatment programmes by 55% from 1998/99 by 31 March 2004 and by 100% by 31 March 2008, increasing year-on-year the proportion successfully sustaining or completing treatment.

2.1 Numbers in treatment NB All figures for 2003/04 are accurate to end of February 2004

How many drug users have had structured treatment to date/planned for future years?

Year	2002/03	2003/04	2004/5	2005/06
Total number in treatment	338	359 to end of Feb	480 (Dec 03 – March 05) 360 forecast	360
% change over previous year (year ending 31/3/02-109)	310%	+6%	+5.5%	0%

NB The DAT has already achieved the required % increase in participation from the baseline figure and will seek to ensure a year on year increase in numbers sustaining or completing treatment.

Commissioning

How many treatment places has the DAT commissioned to date and plan to commission in future years?

Treatment modalities	Treatment places
Treatment modalities	2002/03	2003/04	2004/05	2005/06
In-patient treatment	10	15	42	42
Residential rehabilitation	15	17	15	15
Specialist prescribing	338	359	480 (Dec 03 – March 05) 360 forecast	360
GP prescribing	0	0	25	30
Structured day programmes	17	17	36	36
Structured counselling	32	56	70	70
Totals	412	457	548	553

Successful completion rates (planned discharge)

What percentage targets has the DAT set for successful completions (i.e. planned discharges), within each treatment modality?

Treatment modalities	Completions
Treatment modalities	2002/03	03/04	03/04 % target	04/05	04/05 % target	05/06	05/06 % target ********
In-patient treatment	10	15	60%	38	70%	38	70%
Residential rehabilitation	9	10	60%	9	70%	9	70%
Specialist prescribing	40***	22	25%	44***	30%	44***	30%
GP prescribing	0	0	-	2	-	3**	-
Structured day programmes	12	9	30%	12	35%	19	35%
Structured counselling	17	29*	60%	55	70%	55	70%
Totals	88	85		160		168

*10 ongoing but stable

** Difficult to predict as this will be a new service provision in 2004/05

*** subutex prescribing available. Discontinued by DHCT in 03/04 but to be reinstated as per new service specs in 04/05. LPSA target are higher but includes those ‘successfully sustained’ in treatment

**** no increased capacity within service provider

2.4 GP shared care

The national target is to increase the numbers of GPs participating in the shared care of drug users to 30%. Please set out the progress that is being made locally and future plans.

Year	2001/02	2002/03	2003/04	2004/05	2005/06
Total number of GPs in DAT	99	101	102	102 (21 practices)	102(21 practices)
% engaged in shared care	-	-	-	5 practices = 24.%	6 practices = 30%

3. Harm reduction initiatives

Government has set targets since 1998 for the reduction of reported injecting drug use and paraphernalia sharing, and increases in the numbers of such drug users who have been vaccinated against hepatitis B.

Injecting drug use

For prevalence of injecting and sharing, please use data collected via the service level agreements in the DAT area

Year	2002/03	2003/04	2004/5
% drug users injecting	75-80%	75-80%	70-75%
% drug users sharing	45-50%	45-50%	35-40%

These figures are based on clients of Poole Addictions Community Team although national data suggest only 40-50% injecting drug use. These figures are based only on clients in contact with the specialist service and Community Pharmacy needle exchange as no accurate recording takes place in relation to shared use. Work will take place this year through the Drugs audit, the new Pharmacy needle exchange contract and the harm minimisation clinic to provide a more accurate picture of use. It will then be possible to measure numbers injecting/sharing and establish areas of work to address need. The high number of users injecting also reflects the increase in clients accessing needle exchange provision.

3.2 Blood-borne virus control

What are the DAT’s targets for numbers of intravenous drug users vaccinated against Hepatitis B?

Year	2002/03	2003/04	2004/5
Target number of vaccinations	0	251	360

Needle exchange programmes

Please enter the number of people the DAT provides needle exchange for at centre-based or outreach/mobile drug specialist facilities, to date and intends to provide in future years. This number should be taken from service level agreements.

Additionally, please enter the total number of possible pharmacy outlets in the DAT area and the percentage that are engaged in needle exchange programmes in the DAT area.

Year	2002/03	2003/04	2004/5
No attending specialist outlets	311 per month-* 512* packs per month (average)	254 per month* (average) 494 packs per month (average)	254 per month *(average) 494 packs per month (average)
No of pharmacies	27	28	28
% in scheme	11.10% (3)	10.70% (3)	10.70% (3)

*The Drug Action Team has records of the number of needles provided and the number of payments to pharmacists but figures for clients attending are not normally provided by the service provider. The increased cost of the provision in 2003/04 does not correlate with the reported reduction in the number of clients attending. (please see 3.1 above)

Reducing drug-related deaths

The national target is to reduce the number of drug-related deaths by 20% by 2004.

Year	2002/03	2003/04	2004/5
Number of drug-related deaths in DAT area	2	2	0

NB The recent DRD was a client known to the addictions team who was released form Prison without having the benefit of a GP which prevented immediate prescribing by the specialist team

4. Criminal justice interventions

The Government aims to reduce drug-related offending by using every opportunity in the criminal justice system to identify drug-using offenders and engage and retain them in appropriate drug treatment programmes.

Enhanced arrest referral (EAR)

Year	2002/03	2003/04	2004/5
Total number of arrests	4698	3402 (to end Dec)	-
Arrest Referrals	392	567 Sept – Feb (268 Poole residents)	1726 (870 Poole residents)
Nos. engaged in Tier 2 EAR	N/a	30 (11%)	138
% referred to Tier 3 & 4	N/a	83 (31%)	25%
% engaged in Tier 3 & 4	N/a	61 (22.7%)	10.3% (to achieve 89 in treatment)

Drug Treatment and Testing Orders (DTTOs)

Year	2002/03	2003/04	2004/5
DTTO Commencements	7	10	16
DTTO Successful completions	4	5	12

5. Quality

Briefly describe how the DAT is ensuring quality in drug treatment services.

The Drug Action Team works with service providers and service users to assess needs.

Explicit monitoring arrangements form part of all contracts and service level agreements and regular contract monitoring and evaluation procedures are in place. Information is used to inform the JCG and future commissioning arrangements.

Contracts are in place for all service providers together with service specifications which set out standards, expected outcomes and performance measures.

Quality service delivery is measured through monitoring successful completions, planned and unplanned discharges and by obtaining feedback from service users and carers

The Drug Action Team funds the SW Peer Audit Project to facilitate QuADS Audits on an annual (ongoing) basis and is working with the NTA Regional Commissioner to improve the identified weaknesses of the process.

Where a QuADS audit has identified that standards are not being met, the Drug Action Team works with providers, whenever appropriate, to address problem areas.

In recognition of the diverse needs of BME communities, the Drug Action Team works with the Dorset Racial Equality Council to identify gaps in service provision and address identified need whenever possible

Waiting times

Waiting times

What are the longest and average waiting times in each treatment modality in the DAT area for the following periods:

Treatment modality	NTA March 2004 target	Longest wait 30 June 2003	Average wait 30 June 2003	Longest wait 30 Sept 2003	Average Wait 30 Sept 2003	Longest Wait 31 Dec 2003	Average Wait 31 Dec 2003
In-patient treatment	2 weeks	13 weeks (65 days)	8.1 weeks (40.5 days)	7.5 weeks (37.5 days)	4.5 weeks (22.5 days)	10.8 weeks (54 days)	7.6 weeks (38 days)
Residential rehab	3 weeks	1 week	1 week	1 week	1 week	1 week	1 week
Specialist prescribing	3 weeks	5.84 weeks (29.2 days)	4.78 weeks (23.9 days)	9 weeks (45 days)	6 weeks (30 days)	5 weeks (25 days)	3 weeks 15 days)
GP prescribing	2 weeks	-	-	-	-	-	-
Structured day care	3 weeks	6 weeks	64weeks	6 weeks	4 weeks	6 weeks	4
Structured counselling	2 weeks	0.8 weeks (4 days)	0.6 weeks (3 days)	0.8 weeks (4 days)	0.45 weeks (2.25 days)	0.6 weeks (3 days)	0.5 weeks (2.5 days)

Performance against targets

Please provide a brief explanation of waiting times that fall outside the required targets and what actions and local targets are being set to address this

In patient detox – Poole has no priority beds and clients are placed on a waiting list for East Dorset. Long waiting times exist for stabilisation prior to detox and clients have been placed in residential treatment to overcome unacceptable waiting times. (New Service specifications due to be implemented in April 2004 will rectify the situation.)

Structured Day Care – As above

Specialist prescribing – During May and June the specialist service was without 5 staff members due to training commitments, maternity and paternity leave, sickness, holidays and staff finding other employment. This led to waiting times above national targets. This situation only existed for a short time and the resumption of normal staffing levels resulted in reduced waiting times.

7. Workforce expansion

The national target is to increase the national workforce establishment by 3000, by 2008.

7.1 Number of staff

Staff group	Staffing establishment at 31/12/03			Planned totals nos. by**
Staff group	Total WTE*	Temporary	Vacancies	March 2005	March 2006
Joint commissioning staff	1			1	1
Service managers	1			1	1
Nurses	2			3	3
Social workers	3			3	3
Counsellors	-			-	-
Psychiatrists/doctors	.27			.27	.27
GP prescribers (number)				5	6
GP liaison workers	1			1	1
Outreach workers	1		1	1	1
Criminal justice workers	2			2.5	2.5
Psychologists	.27			.27	.27
Admin/support staff	1	1		2	2
Occupational therapists
Complementary therapists				.*	*
Others	2 temp student placements

*Staff trained to deliver complementary therapies and others purchased on a sessional basis

**2005/06 Funding unlikely to be available to increase staff levels

7.2 Ethnic Monitoring

For all staff please indicate how many are:	Practitioners	Managers	Commissioners
Asian or Asian British (Bangladeshi)
Asian or Asian British (Indian)
Asan or Asian British (Pakistani)
Asian (Other)
Black of Black British (African)
Black or Black British (Caribbean)
Black (Other)
Chinese
Mixed White and Black African	1
Mixed White and Black Caribbean
Mixed White and Asian
Mixed Other
White British	12	1	1
White Irish
White other
Other ethnic background
Not Stated
Total	13	1	1

8. Funding

Please detail all funding available to the joint commissioning group to support delivery of the DAT treatment plan.

Funding source	Amount in 2003/04	Amount in 2004/05	Amount in 2005/06
NTA Pooled Treatment Budget (PTB)	410,000	410,000	433,000
NTA PTB underspend carried forward from previous year	198,000	150,000 (accommodation)	nil
HO arrest referral	31,857	31,857	31,857
Police (inc. ARS)	9,540	11,040	11,260
CJIP (if applicable)	N/a	N/a	N/a
HO after/throughcare	35,000	70,826	70,826
PCT mainstream	330,000**	382,450**	366,639**
Social services	238,000 *additional allocation of £30,000 made mid year to support shortfall in residential budget	282,566 +plus provision of Poole Addictions Community Team accommodation running costs	288,217
Probation (inc. DTTO)*	Funding not available to the JCG	Funding not available to the JCG	Funding not available to the JCG
*Supporting peoplenot included In treatment Plan as no funding received or finalised for 2004/05**	0000	42,000	42,000
Other: (please specify)
BSc	61,000	65,662	67,301
Drug Action Team/CAD	31,000	30,000	-

	Amount in 2003/04	Amount in 2004/5	Amount in 2005/06
Total funding	1,344,397	1,434,401	1,269,100
Young people’s PTB	41,000	54,481	56,375
Total: Adult treatment	1,303,397	1,379,920	1,212,725

Has the DAT created a pooled budget for drug treatment, fully available to the joint commissioning group?

YES /

DATs in receipt of the NTA pooled treatment budget since 2001 must maintain mainstream investments, including inflation uprating, which is subject to audit checking. Lead PCT directors of finance will be required to verify this through the local delivery plan (LDP) reporting process.

Have all mainstream funding commitments been maintained and inflation uplifted?*

YES

*If the answer is NO, please supply a written explanation as an appendix to this strategic summary.

** There is still no agreement to the level of mainstream funding used by S&E Dorset PCT to commission Dorset Healthcare NHS Trust. The Drug Action Team is still not able to commission services in its area from this funding which is meant to provide treatment services for Poole

Poole

Drug Action Team

Adult drug treatment plan 2004/05

Part 2: Self-assessment checklist

Submitted to NTA: 19 March 2004

Introduction

Part 2 of the drug treatment plan (Self-assessment checklist) should be completed in accordance with section two of the corresponding guidance.

This self-assessment checklist replaces the gap analysis in last year’s treatment plan.

The criteria for self-assessment is summarised below:

RED	Not in place or not at standard required and significant need/improvements identified
AMBER	Progress being made but further work/investment required to meet identified need/standard
GREEN	Provision in place and/or good progress being made against assessed need and required standards
N/A	Provision/service not needed because no need identified in DAT area

Tier 1 - Non-drug treatment specific services

Tier 1 consists of services offered by a wide range of professionals (e.g. primary care medical services, generic social workers, teachers, community pharmacists, probation officers, housing officers, homeless persons units). Tier 1 services work with a wide range of clients including drug users, but their sole purpose is not simply substance misuse

Assessment of services, provision and standards	Red/Amber/Green
Drug services have procedures to refer into all tier 1 services	AMBER
Basic drug awareness training for staff in:
Primary care practices	AMBER
Community pharmacies	GREEN
General medical/surgical services	AMBER
Maternity services	AMBER
General psychiatry	AMBER
A&E services	AMBER
Communicable disease services	AMBER
Housing services	GREEN
Vocational services	AMBER
Social services	GREEN
Education services	GREEN
Police	AMBER
Probation service	AMBER
Prisons within the DAT area	AMBER

NB The Drug Action Team has a programme of free training (now being linked to DANOS) available to each of these agencies. However, not all services choose to access the provision despite strenuous efforts on the part of the Drug Action Team

Assessment of services, provision and standards (Tier 1 cont)	Red/Amber/Green
Screening, assessment and referral procedures to drug treatment services in place for staff to follow:
Primary care practices	AMBER
Community pharmacies	AMBER
General medical/surgical services	AMBER
Maternity services	AMBER
General psychiatry	AMBER
A&E services	AMBER
Communicable disease services	AMBER
Housing services	GREEN
Vocational services	AMBER
Social services	GREEN
Education services	GREEN
Police	AMBER
Probation service	GREEN
All agencies working with young people ie connexions,YOT	GREEN
Progress to Work/ Jobcentre staff	GREEN
Prisons within DAT area	GREEN
Prevention, screening, testing, immunisation and treatment services for blood borne viruses	RED
Supported housing and other housing available for drug users	GREEN
Progress2Work and other education, employment and training services available for drug users	GREEN
Overall assessment of coverage and quality of Tier 1 services, provision and standards	AMBER

Tier 2 - Open access services

Services within this tier aim to provide accessible services for a wide range of substance misusers referred from a variety of sources, including self-referrals. The aim of the treatment in this tier is to help substance misusers to engage in treatment without necessarily requiring a high level of commitment to more structured programmes or a complex or lengthy assessment process. Services in this tier include needle exchange programmes and other harm reduction measures, substance misuse advice and information services and ad hoc support not delivered in a structured programme of care.

Assessment of services, provision and standards	Red/Amber/Green
Community care assessment	GREEN
Care co-ordination arrangements for all four tiers, including integrated criminal justice referral pathways	AMBER
Screening and assessment protocols from Tier 2 to Tiers 3 and 4	GREEN
Open access advice and information service including motivational and brief interventions	GREEN
Pharmacy, centre based, and, if appropriate, outreach needle exchange with full range of harm minimisation equipment and information	AMBER
Outreach services (detached, peripatetic and domiciliary ) targeting high risk and priority groups	AMBER
Prevention, screening, testing, immunisation and treatment services for blood borne viruses	RED
Low threshold prescribing	GREEN
Programme of overdose training supported by overdose agreements	RED
Overall assessment of coverage and quality of Tier 2 services, provision and standards	AMBER

Tier 3: Structured community-based drug treatment services

This Tier can be defined as providing services solely for substance misusers in a structured programme of care. Services within this Tier include therapeutic interventions (e.g. CBT, MET), structured methadone maintenance programmes, community detoxification, or structured day care (either provided as a drug-free programme or as an adjunct to methadone treatment). Structured community-based aftercare programmes for individuals leaving prisons are also included in Tier 3.

Assessment of services, provision and standards	Red/Amber/Green
Specialist prescribing
Access for users from all parts of the DAT area	GREEN
Adequate prescribing capacity and target numbers in treatment	GREEN
Waiting times target of 3 weeks achieved or bettered	GREEN
Prescribing options available in line with Models of Care	AMBER
Published clinical governance arrangements	RED
Adherence to clinical guidelines evidenced	AMBER
Prevention, screening, testing, immunisation and treatment services for blood borne viruses	AMBER
GP prescribing
More than 30% of GPs in shared care	RED
Training given to all GPs participating in shared care and all other GPs on request	RED
Access for users from all parts of the DAT area	RED
Adequate prescribing capacity and target numbers in treatment	RED
Waiting times target of 2 weeks achieved or bettered	RED
Prescribing options available in line with Models of Care	RED
Published clinical governance arrangements as part of Shared Care Monitoring Group protocol	RED
Adherence to clinical guidelines evidenced	RED
Prevention, screening, testing, immunisation and treatment services for blood borne viruses	RED
Assessment of services, provision and standards (Tier 3 cont)	Red/Amber/Green
Structured day care
Access for users from all parts of the DAT area	GREEN
Waiting times target of 3 weeks achieved or bettered	GREEN
Abstinence and harm reduction services available	GREEN
Service has clearly defined evidence based programme and criteria for client preparation, retention, completion and aftercare	GREEN
Prevention, screening, testing, immunisation and treatment services for blood borne viruses	AMBER
Structured counselling
Access for users from all parts of the DAT area	GREEN
Waiting times target of 2 weeks achieved or bettered	GREEN
Range of structured, care planned counselling and therapies	GREEN
Prevention, screening, testing, immunisation and treatment services for blood borne viruses	AMBER
Aftercare/throughcare
Access for users from all parts of the DAT area	GREEN
Access for all users post all structured treatment interventions	GREEN
Access for all users on release from custody	GREEN
Liaison services
Acute medical and psychiatric services for pregnant drug users	GREEN
Acute medical and psychiatric services for drug users with mental health problems	GREEN
Social services, including child protection and family services	GREEN
Social care including housing and homelessness	AMBER
Overall assessment of coverage and quality of Tier 3 services, provision and standards	GREEN

Tier 4(a): Residential and inpatient drug treatment services

Services in this tier are aimed at those individuals with a high level of presenting need and include inpatient drug treatment, detoxification and residential rehabilitation. Tier 4a services usually require a higher level of motivation and commitment from the substance misuser than for services in lower tiers. This tier also covers supported housing.

Assessment of services, provision and standards	Red/Amber/Green
Inpatient treatment
Access for users from all parts of the DAT area	GREEN
Waiting times target of 2 weeks achieved or bettered	GREEN
Discharge and throughcare/aftercare planning	GREEN
Prevention, screening, testing, immunisation and treatment services for blood borne viruses	AMBER
Residential rehabilitation
Access for users from all parts of the DAT area	GREEN
Waiting times target of 3 weeks achieved or bettered	GREEN
Range of choice available	GREEN
Discharge and throughcare/aftercare planning	GREEN
Prevention, screening, testing, immunisation and treatment services for blood borne viruses	AMBER
Accommodation funded through Supporting People for drug users	RED
Overall assessment of coverage and quality of Tier 4 services, provision and standards	GREEN

Workforce development

Assessment of services, provision and standards	Red/Amber/Green
DAT workforce strategy
DAT recruitment and retention strategy across statutory and voluntary sector	RED
DAT and provider services recruitment policies demonstrate equality of opportunity and plans for increasing percentage of BME workers	GREEN
Service Level Agreements specify required workforce activities E.g. induction, individual training plans, contingency planning, etc.	GREEN
Service Level Agreements include funding for training and development of staff within provider services	GREEN
Human resources policies
All agencies and providers compliant with Race Relations Amendment Act	GREEN
Human resource policies and practice in provider services include staff appraisal, supervision, individual development plans	GREEN
All drug service job descriptions, person specifications and recruitment processes expressed in line with DANOS	AMBER
Training and development
Training and development strategy and plans across the drug action team and its partner agencies reflect outcomes of NTA/Cranfield training needs analysis and any local training needs analyses	RED
Provider services working towards creating a supportive learning environment	GREEN
Training and development plans in provider services reflect NTA/Cranfield training needs analysis and demonstrate how organisational, team and individual needs will be met	RED
DAT/provider service training plan includes specific focus on how to assess and meet the needs of: clients as parents and clients’ children	GREEN
Trainee or apprenticeship schemes in provider services	GREEN
Volunteer development schemes in provider services	GREEN

Assessment of services, provision and standards (Workforce cont)	Red/Amber/Green
Workforce monitoring
NTA workforce monitoring system for providers and commissioners to provide required quarterly returns	GREEN
Overall assessment of DAT and provider workforce strategy	GREEN

Under-served groups

This planning grid focuses on the strategic planning process to develop appropriate services for populations who are not fully represented within drug treatment services.

Assessment of services, provision and standards	Red/Amber/Green
DAT diversity policy	AMBER
Crack cocaine and other stimulant users
Prevalence research (nature and extent of drug use)	AMBER
Needs assessment research re. identifying social and health care needs of crack cocaine and other stimulant users	AMBER
Service mapping - identifying gaps in service provision (inc. training needs) and regularly reviewed	AMBER
Black and minority ethnic (BME) drug users
Needs assessment research re. identifying social and health care needs of BME drug users	RED
Service mapping – identifying gaps in service provision (inc. training needs) and regularly reviewed	RED
Development of Race Equality Scheme (in line with Race Relations Amendment Act) for all partners and providers	AMBER
Women drug users
Needs assessment research re. identifying social and health care needs of women drug users	AMBER
Service mapping – identifying gaps in service provision (inc. training needs) and regularly reviewed	AMBER
Rural communities
Prevalence research (nature and extent of drug use) in rural communities	NA
Needs assessment research re. Identifying social and health care needs of drug users in rural communities	NA
Service mapping - identifying gaps in service provision (inc. geographical access issues, training needs etc.), and regularly reviewed	NA

Assessment of service, provision and standard (Under-served groups cont)	Red/Amber/Green
Homeless and rough sleepers
Needs assessment research re. Identifying social and health care needs of homeless and rough sleepers	AMBER
Service mapping – identifying gaps in service provision (inc. training needs) and regularly reviewed	AMBER
Overall assessment of coverage and quality of services, provision and standards to meet needs of under-represented groups	AMBER

DAT systems and infrastructure

This planning grid focuses on the implementation of the Models of Care framework, specific areas where DATs should have joint action plans with other partners, together with the full range of commissioning activities, financial and information infrastructure that is required to ensure that there is best value, providing a robust and comprehensive system to support the drug treatment system. It should also cover plans for publication and consultation on the Treatment Plan

Assessment of service, provision and standard	Red/Amber/Green
Models of care
Implementation group operational on a multi-agency basis with user and carer representation	GREEN
Audit against Models of care standards and NTA service specifications	GREEN
Agreed, published screening, referral, triage and assessment protocols	AMBER
Directory of services including eligibility criteria and full information for users and carers produced and widely available. Process for updates in place.	GREEN
Information sharing policy between services agreed and published	AMBER
Integrated care pathway arrangements	AMBER
Care co-ordination arrangements and documentation	AMBER
DAT/Partner action plans
Waiting times
Management and reduction of waiting times	AMBER
Training in the use of service improvement tools and techniques	AMBER
Criminal justice
Protocol with criminal justice system to maximise the identification, engagement and retention of drug using offenders	GREEN
Drug-related deaths
Action plan on reducing drug related deaths	RED
Assessment of service, provision and standard (DAT systems and infrastructure – cont)	Red/Amber/Green
Dual diagnosis
Joint strategy/action plan for cases of co-morbidity with Mental Health Local Implementation Team	AMBER
Protocols for the management of drug and alcohol dependence
The DAT and the Adult Mental Health Local Implementation Team have agreed and implemented joint protocols for the management of drug & alcohol dependence	AMBER
Commissioning function
Commissioning manager post	GREEN
Financial and legal advice including robust financial reporting systems	GREEN
Pooled treatment budget (PTB) management arrangements including carry forward arrangements	GREEN
Mainstream investments identified and investment being tracked	AMBER
Minimum uplift by all in line with inflation from all partners funding drug treatment services	GREEN
Contract management arrangements – including costed service level agreements and performance targets for all mainstream and PTB spend	GREEN
Framework for quality standards in all services	GREEN
Terms of reference for joint commissioning group (JCG) agreed with NTA regional manager and in operation	GREEN
Core membership of JCG from health, probation, police and social services at an appropriate level and fully participating	GREEN
DAT area targets for treatment PSA for the coming year have been agreed at JCG by all DAT partners	GREEN
DAT area targets for shared care for the coming year have been agreed at JCG by all DAT partners	AMBER
DAT area targets for reducing drug related deaths have been agreed at JCG by all DAT partners	RED
DAT area DTTO targets for the coming year have been agreed at JCG by all DAT partners	GREEN
Assessment of service, provision and standard (DAT systems and infrastructure – cont)	Red/Amber/Green
Information systems
Information system and evidence that information used appropriately to support commissioning decisions	GREEN
Compliance with NDTMS returns from all providers	AMBER
Compliance with NTA minimum data set requirements	AMBER
Web based information system for all providers which can be accessed directly by commissioning manager	RED
Consultation on, and public access to, treatment plan
Consultation undertaken with service providers during year and specifically on preparation/implementation	GREEN
Consultation undertaken with service users during year and specifically on preparation and implementation	AMBER
Consultation undertaken with carers during year and specifically on preparation and implementation	RED
Consultation undertaken with relevant others during the year and specifically on preparation and implementation	GREEN
Treatment plan in complete and summary form made accessible to the public and local communities (e.g. via web site, local media, libraries and health centres etc)	GREEN
Overall assessment of DAT systems and infrastructure	GREEN

Users and carers

This planning grid focuses on the involvement of users and carers in the design of the local treatment system and their involvement throughout the implementation, monitoring, review and evaluation processes. The grid should cover the development of advocacy services.

Assessment of service, provision and standard	Red/Amber/Green
Action plan tied to DAT treatment strategy and wider service user and carer strategy which includes current, ex and potential service users and carers	RED
Mentoring, training and development action plan in place, including remuneration for involvement of service users and carers in DAT activities	AMBER
Network of advocacy and support services which involves, where appropriate, PALS (NHS), local authority and independent sector	RED
Involvement of service users and carers in DAT structures	GREEN
Service users and carers involved in setting DAT plan priorities and consulted on plan at draft stage, and throughout the process	AMBER
Evidence that service user and carer consultation has resulted in action at DAT/provider level	RED
Overall assessment of coverage and quality of services, provision and standards to meet needs of users and carers	AMBER

Poole

Drug Action Team

Adult drug treatment plan 2004/05

Part 3: Planning grids

Submitted to NTA: 19 March 2004

Introduction

Part 3 of the drug treatment plan (Planning grids) should be completed in accordance with section three of the corresponding guidance.

The planning grids remain the same as for last year, other than the gap analysis which is replaced by the self-assessment checklist (part 2).

Planning grid 1: Tier 1 – Non-drug treatment specific services

Box 1: Summary of self-assessment – Tier 1- Overall assessment –Amber

Comprehensive drug training programme in place and available to all providers/services in the Drug Action Team area although not all agencies accessing the free provision.

Screening, assessment and referral (SAR) procedures not fully developed in line with Models of Care (MoC) across all adult services

No Tier 1 service provision for screening, testing, immunisation and treatment for blood borne viruses

The main gaps in SAR provision centre around general medical services ie GP’s. A&E, psychiatry and a major identified gap exisits in relation to blood borne virus services – the only existing provision is through referral to the GUM clinic in the Bournemouth Drug Action Team area

Box 2a: Objectives from 2003/04 – updated and continuing – Tier 1

1 Young peoples drug screening and referral tool (SUST) developed and implemented. Further work needed to ensure effective use by all agencies

2 Supported accommodation available – continue to work with Housing and Community Services to increase the number of units available

3 Continue to develop and promote the Borough wide drug awareness programme in line with DANOS

4 To work in partnership with Bournemouth and Dorset Drug Action Team’s to develop and implement a consistent screening tool as part of MoC implementation

5 Under the agreed protocol, encourage Poole police custody staff to facilitate increased voluntary drug testing

Box 2b: New objectives for 2004/05 – Tier 1

6 Work with PCT to establish funding mechanism and GP referral to Poole Addictions Community Team harm minimisation clinic for testing and immunisation for bloodborne viruses

7 Use ‘one off’ funding to deliver effective training on Hepatitis C to a range of health care professionals

8 Increase the range of training available to pharmacists through joint working with the PCT Pharmaceutical Advisor and the PACT GP liaison Nurse

Box 3: Planned spend 2003/04

£34,500 (Pooled Treatment Budget £18,000)

Box 4: Likely spend 2003/04

£25,019 (Pooled Treatment Budget £0)

Box 5: Planned spend 2004/05

£5,500 (£4,000 Pooled Treatment Budget)

(£1,500 m/s) Total £5,500

Box 6: No

Box 7: Actions/Milestones – Tier 1

Box 8: By when

Box 9: By whom

Box 10: Costs

Encourage agencies to provide quarterly reports to the Drug Action Team Young People’s Sub Group identifying the number of young people screened

Named representative from each agency to be responsible to the YP sub group for returns on behalf of their employing agency

2.1 Continue to support 5 units of accommodation through Poole

Addictions Community Team (PACT) and Poole Aftercare

Service (PACS) (Supporting People funding)

Increase the available provision by the addition of 6 ‘new build units. Partnership arrangement with Housing and Community services

Provide 750 free training places to Borough wide drug awareness training (Stage 1,2 or 3) linked to accreditation through DANOS (Two year programme for 2003 –2005 commissioned)

Two year administration of training programme commissioned

4.1 In partnership with Bournemouth and Dorset Drug Action Team’s

continue to develop clear local guidelines and screening and

referral mechanisms for all Tier 1 Services

5.1 Through the Pan Dorset Criminal Justice steering Group, engage with Police to encourage increased drug testing in Poole Custody

Suite

6.1 In partnership with the PCT, develop a mechanism for providing funding to enable GP’s to refer drug using patients to the PACT Harm minimisation clinic for testing and vaccination for blood borne viruses (See grid 3-10.1)

7.1 Deliver Pan Dorset Hep C awareness training to GP’s and other healthcare professionals and circulate advice and information leaflets in the wider public domain

8.1Agree a new and comprehensive pharmacy training programme to include basic drug awareness, screening and assessment, harm minimisation information etc (sponsorship to be sought whenever possible)

Quarterly returns – January, April ,July and September 2004

As above

Ongoing

July 2004

March 2005

February 2004

April 2004

July 2004

March 2004

Ongoing through 2004/05

All agencies working with young people

Relevant member of YP sub group

PACT/PACS

DAT/Housing Services

DATs funded/delivered by EDDAAS

Adult Social Services

Moc lead/3 DATs

Police partnership and diversity development superintendent

Poole PCT

Dorset,Bournemouth and Poole DATs

PCT pharmaceutical advisor/PACT GP liaison nurse

Zero cost

See Grid 3:4.5/6.1

Funding already in place

£20,000

Funded from DAT/CAD and BSC 2003/04 funding

£2,500 Funded from DAT/CAD and BSC 2003/04 funding

See Grid 7

£3,500 (£2,000 PTB/£1’500 Police)

See Grid 3: 10.1

£7558 County wide = £2519 ‘one off’ funding 2003

£2000 PTB

*9.1

Total cost Box 10:

£5,500

Box 11a: Quarterly progress report to DAT – Tier 1 Quarter 1 2 3 4 (Please circle appropriate quarter)
Box 11b: Action point	Box 11c: Progress to date	Box 11d: Further action

Planning grid 2: Tier 2 - Open access services

Box 1: Summary of self-assessment – Tier 2 Overall assessment – Amber

Overall the assessment shows good progress towards ‘Green’ for Tier 2 services. Good screening and referral mechanisms exist between teir 2 and tier 3 services in Poole, the newly established enhanced Arrest Referral Scheme is working well and a new harm reduction service is planned by PACT as soon as its new premises are available. Historic contractual obligations inherited by the Drug Action Team only provide Pharmacy needle exchange from 3 locations but plans for the re tendering of the contract and close working with the PCT is intended to increase provision.

As with tier 1, services for tackling blood borne viruses have been identified as a gap in provision and difficulties have been experienced in commissioning overdose training.

Box 2a: Objectives from 2003/04 – updated and continuing – Tier 2

1 Community Pharmacy Needle Exchange service specification revised.

Harm minimisation service expanded (PACT)

Work with Dorset Ambulance Trust to deliver overdose training and develop protocol

Continue to promote local services

Commission effective service provision from within the voluntary sector

Continue to develop links between the three Dorset Arrest Referral Schemes and extend the service provided by the integrated CJIP team within Poole Addictions Community Team /Poole Aftercare Project

Box 2b: New objectives for 2004/05 – Tier 2

Develop robust care-co-ordination arrangements in line with MoC

Develop outreach facilities to target ‘hard to reach’ groups

Box 3: Planned spend 2003/04

£195,643 (£77,875 Pooled Treatment Budget)

Box 4: Likely spend 2003/04

£211,791 (£68,800 Pooled Treatment Budget)

Box 5: Planned spend 2004/05

£56,341 m/s

£41,397 EARS

£159,794 (PTB)

£70,826 (CJIP)

TOTAL £328,358

Box 6: No

Box 7: Actions/Milestones

Box 8: By when

Box 9: By whom

Box 10: Costs

Current Pharmacy Needle Exchange contract over budget - Notice given to provider of intention to re tender contract

Pan Dorset working group established to oversee new contract tendering process. Contract out to tender

New pharmacy needle exchange (supply) contract in place. New pack content to include harm minimisation paraphernalia, advice and information

Pan Dorset work progressed to review and amend pharmacy guidelines/contracts

Blood borne virus advice and information literature to be made available through pharmacies and specialist services

2.1 Following access to new PACT accommodation, deliver weekly

harm minimisation clinics to include needle exchange, health

screening, blood borne virus service, overdose prevention training

and first aid

2.2 Meet the recurrent cost of the PACT harm minimisation ‘E’ Grade

nurse (Clinical governance provided by PACT G Grade nurse)

Capacity to carry a caseload of up to 25.

Meet the recurrent cost of needle exchange/floating support worker 2.5% inflationary uplift. To be responsible to PACT Practice Supervisor for the maintenance of records in compliance with service specification data collection requirements for harm minimisation and needle exchange NB Consideration to be given to changing the post to a general health care nurse to increase the number of clients provided with general healthcare and harm minimisation advice.

Meet recurrent cost of drug paraphernalia for PACT daily needle exchange and weekly harm minimisation clinic

Meet recurrent costs of Hepatitis B immunisations and blood testing for PACT clients (360 new clients per annum @£42 per vaccine)

Work with CDRP to undertake Drugs Audit and ascertain an accurate reflection of PDU’s in the Drug Action Team area together with data relating to injecting drug use and the sharing of equipment

3.1 Commission Dorset Ambulance Trust as training provider to deliver

programme of overdose prevention training

4.1 Continue to provide advice and information literature promoting

local service provision, including revised service directory, to

professionals, service users and the wider public

5.1 Meet recurrent core funding for East Dorset Drug and Alcohol

Advice Service (EDDAAS) to include 2% inflationary uplift

5.2 Meet recurrent funding for EDDAAS adult outreach provision plus I

inflationary increase of 2.5%

5.3 Meet recurrent funding for South Wessex Addiction Centre (SWAC)

plus inflationary increase of 2.5%

6.1 Meet recurrent cost of Enhanced Arrest Referral Scheme (to include

1 f/t ‘E’ Grade nurse (clinical governance provided by PACT G

Grade nurse) Management, IT and administration costs) integrated

within PACT.

NB This new service provision ensures priority referral to treatment

through Poole Addictions Community Team, provides the

opportunity for engaging users with limited motivation and

establishes immediate links to be established with the prison

liaison worker. The three Dorset schemes are monitored to ensure

consistency through the Pan Dorset Criminal Justice steering Group

Meet the recurrent cost of structured day care places for Arrest referral clients seen through PACT (285 episodes at £35 per session)

Work with PACT and the police to commission appropriate low level threshold treatment interventions for clients needing further treatment on release form Prison and for clients identified through the Persistent Offender Scheme

Use new CJIP funding to extend the current aftercare provision to provide an enhanced throughcare/aftercare provision for those returning to the community on release from Prison to include additional support for new ‘Supported accommodation’ due for completion in 2004 and outreach support services to assist reintegration into the community.(To include ‘out of hours service’ with support available at weekends). New provision to from part of a fully integrated CJIP Team. (Plans comply with guidance and have been ‘signed off’ by GODT)

Establish new clerical officer post to be responsible to the administration manager for information collection and supporting CJIP/PACT staff

7.1 To work with Bournemouth and Dorset DATs and service providers

to develop effective care co-ordination in line with models of care.

As an interim measure agencies will be required to provide ‘in

house’ care co-ordination which may lead to a reduction in service

provision due to new service delivery from within existing

resources. The DATs will seek funding to develop a dedicated care

co ordination service for clients whose needs cross several areas

and who require co-ordination of care on behalf of each of the

services and agencies involved It is estimated that each worker

could case carry 25 clients and that a minimum of three workers

(suitably trained) would be required to meet the needs of Poole

Addictions Community Team clients with complex needs NB In

recognition of financial constraints work is in progress to link the

care co-ordination role of the specialist service with an

advocacy/mentoring role provided by the Service User forum

Work in partnership with ‘Faithworks’ (Routes to Roots) to deliver a dedicated 2 year post (20 hours per week) to work in the local ‘soup kitchen, undertake outreach work with the homeless and provide weekend ‘drop in sessions’ for the homeless and vulnerable at premises in the Town Centre

August 2003

December 2003

April 2004

June 2004

April 2004

March 2005

June 2004

Ongoing

April 2004

December 2003-March 2004

April 2004

April -September 2004 ( Interim)

October 2004

January 2004

DAT Co-ordinator

Bournemouth JCO

Pan Dorset Commissioners

N/E working Group

PACT harm minimisation nurse

DAT JCO

DAT/CDRP

DAT JCO

DAT Co-ordinator

DAT JCO

DAT JCOs

DAT JCO

Drug Action Team Co-ordinator

DATs JCOs

PACT Practice Manager

DAT Joint Commissioning Officer

Faithworks (Poole)

Zero cost

Not known(PTB)

(£20,000)

Not known (PTB)

(£12,000?)

£1000 (PTB)

See below

£24,000 (PTB)

£19,218 (PTB)

(The figure below has been used instead in the calculation of total spend)

£24,000 (PTB)

£15,000 (PTB)

£15,120 (PTB)

*9.2

Zero cost

£2,200 (M/S)

£2,500 PTB

*9.3

£33,393 M/S

£8,160 M/S

£7,462 (PTB)

£10,965 (PTB)

£1,088 M/S

£1,122 (PTB)

(See Grid 3:7.2)

£41,397 (Police and Home office funding)

£5,000 m/s

£10,000 (CJIP)

£15,000 (CJIP)

£35,000 (CJIP 2003)

Fund new service provision for 2004/05 -£35,540

£10,286 CJIP

£6,500 M/S

Zero cost

3 X £17,750 per annum = half year cost of

£26,625 (PTB)

* 9.5

£20,000 DAT/CAD 2003/04 funding

£4,000 Routes to Roots

Total costs Box 10:

£328,358

Box 11a: Quarterly progress report to DAT – Tier 2 Quarter 1 2 3 4 (Please circle appropriate quarter)
Box 11b: Action point	Box 11 c: Progress to date	Box 11d: Further action

Planning grid 3: Tier 3 - Structured community-based services

This Tier can be defined as providing services solely for substance misusers in a structured programme of care. Services within this Tier include structured cognitive behaviour therapy programmes, structured methadone maintenance programmes, community detoxification, or structured day care (either provided as a drug-free programme or as an adjunct to methadone treatment). Structured community-based aftercare programmes for individuals leaving prisons are also included in Tier 3.

Box 1: Summary of self assessment – Tier 3 Overall assessment- Green

The two priority areas for improvement in 2004/05 are GP Prescribing and Blood borne Virus services. Despite efforts by the DAT and the PCT Poole still has no formal shared care arrangements.

As a result of inadequate accommodation for PACT there has been very a limited number of clients benefiting form Hepatitis B immunisation through the specialist service, despite this being an identified priority for the DAT.

Clinical Governance can be evidenced within existing service provision but it accepted that a more robust method of monitoring should be established. This has been addressed in part by the development of new service specifications for Dorset Healthcare NHS Trust (DHCT) (the current service provider)

In other areas the continued development of the Poole Addiction Service is achieving effective and diverse service delivery to meet the needs of clients although inadequate accommodation and a fluctuation in staff numbers has had an effect on the capacity of the team

Box 2a: Objectives from 2003/04 – updated and continuing – Tier 3

1Continue to work with Bournemouth and Dorset DATs, supported by the NTA and the S&E Dorset PCT, to identify mainstream spend

2Work with DHCT to deliver services in accordance with new service specifications underpinned by new contractual arrangements

3New premises for PACT identified. Funding to be provided to facilitate the move and ensure the accommodation meets the needs of service users and providers

4Review and consolidate the work of PACT to ensure that it is able to meet the diverse needs of service users in line with Models of Care

5Continue to work with the PCT to engage GPs in Shared Care arrangements

6Work with EDDAAS aftercare project to increase its capacity,

7 Continue to deliver effective treatment provision for clients subject to DTTO’s

8Continue to develop the dedicated Young people s treatment Service - YADAS

Box 2b: New objectives for 2004/05 – Tier 3

9Work with service providers and the PCT to ensure robust and effective clinical governance

10Work with PACT, GPs and the PCT to ensure adequate blood borne service provision is in place within the specialist prescribing service

11Work with the Mental Health LIT and the PCT to identify need and ensure dedicated local service provision for clients with dual diagnosis.

Box 3: Planned spend 2003/04 – Tier 3

£838,060* (£317,560PTB)

*Includes estimated Mainstream spend – still to be confirmed

Box 4: Likely spend 2003/4 – Tier 3

£458,283 M/S £385,604 (PTB)

Total £843,887

Box 5: Planned spend 2004/05 – Tier 3

£407,038 m/s

£95,662 external funding (BSC/DAT/CAD)

£252,624 (PTB) +£150,000c/f

TOTAL £905,324

Box 6: No

Box 7: Actions/Milestones – Tier 3

Box 8: By when

Box 9: By whom

Box 10: Costs

Work through the Pan Dorset JCG, supported by the NTA, to identify and agree historic mainstream spend. ( To be apportioned as 56% B’mth.27% Poole,17% Dorset)

Following agreement of funding levels to devolve funding to the Drug Action Team to facilitate full and effective commissioning of DHCT £351,000?? To include 30 new referrals to Sedman Unit for structured day care

2.1New Service Specifications completed and forwarded to DHCT for

comment/agreement

2.2 Work with DHCT and locality teams to ensure delivery of service

provision in line with new service specifications

2.3 Establish new data collection mechanism and agree data sharing

arrangements with DHCT/Poole Addictions Community Team and

other providers to enable Drug Action Team to provide statistical

reports as required and to inform future service development

3.1 Commission detailed project plans service specification and

contract for required work (to include telephones and It equipment)

4.1 Meet the recurrent costs of PACT practice supervisor, senior

practitioner and social worker and costs associated with line

management (plus 2.5% inflationary uplift)

4.2 Meet the recurrent costs of PACT G Grade nurse (plus 2.5% inflationary uplift). Capacity to carry caseload of no more than 25. Clinical Governance provided by DHCT

Maintain PACT working budget for rates, lighting phones etc

Establish new F grade nursing post within Poole Addictions Community Team to provide support for community detoxification Clinical Governance provided by PACT G Grade nurse. Target 30 detox per year.

Meet recurrent cost of outreach/floating support worker (plus 2.5% inflationary uplift) Capacity to support PACT clients in 5 units of supported accommodation

Meet recurrent cost of PACT administration office manager (plus 2.5% inflationary uplift) Capacity to support 13 PACT staff members

Meet recurrent cost of PACT Prison Liaison Worker (plus 2.5% inflationary uplift) Capacity to carry caseload of no more than 25.

Meet recurrent costs of PACT saliva testing equipment. NB the large increase in client referrals has resulted in a substantial overspend on this budget. Funding for drug testing is included in mainstream spend and should be diverted to cover some of the additional cost. Consideration should be given to alternative testing methods.

Meet recurrent costs of childcare provision for PACT clients (plus 2.5% inflationary uplift) (10 children per month x 10 clients at women’s only clinic £925 per annum and 2 children attending 5 session per week per year £15 per session per child for 5 days for 20 weeks = £3000

Meet the recurrent cost of pharmacist fees for supervised consumption

Meet the recurrent cost of pharmacists training provided by PACT relating to supervised consumption, harm minimisation, general healthcare and other issues as requested by pharmacists. (Bi-monthly training for up to 15 pharmacists per session) NB New links established with PCT Pharmaceutical rep)

Meet recurrent costs of Hepatitis B immunisation. (see Planning Grid 2-2.5)

Meet the recurrent costs of complementary therapies and continue to expand the range of service provision. NB PACT staff training to be able to reduce future commissioning costs through ‘in house’ delivery(250 x client places per annum – acu detox, 208 x client places – yoga, Two practitioners trained to deliver Reiki, one practitioner trained to deliver Acu-detox)

Meet the recurrent cost of structured care-planned counselling for PACT clients (as per agreed contract) 8 clients per week @ £30 per session (416 episodes)

Meet the recurrent cost of the p/t G grade pharmacy liaison post (plus 2.5% inflationary uplift). Post to increase number of pharmacists delivering supervised consumption (from 5 to 7) and liaise with PCT pharmaceutical rep in relation to pharmacy and GP training

Meet the recurrent cost of the p/t G grade pharmacy liaison post (plus 2.5% inflationary uplift). This post to work with GP’s to engage with and provide support within GP Practices in relation to Shared Care arrangements NB This post is funded until December 2004 from the reinstated community detoxification funding for 2004/04 (£18,360)

PACT practice supervisor to identify staff to undertake the interim care co-ordination role for clients with complex needs

Work with the PCT in relation to new GP contracts to engage

GP’s in formal shared care arrangements and to seek the Support of the NTA GP regional representative. (Target 6 GP’ engaged)

Seek GP representation on the DATs Treatment sub group

which will also be the Shared Care Monitoring Group

Work with the PCT to engage a GP prepared to take responsibility for Poole Addictions Community Team clients who are not registered with a GP to facilitate specialist prescribing

Meet the recurrent funding for the EDDAAS Aftercare project (plus 2.5% inflationary uplift). Work with PACT in relation to aftercare provision for clients in supported accommodation and explore ways of expanding the service to accommodate the increased referral rate.

Meet recurrent treatment costs for DTTO’s as per existing contracts Current target 11 commencements. Two tier provision available.

Non intensive placements – 5 clients @ £2155 per client

Intensive placements - 5 placements delivered through structured day care and residential placements

7.4 Additional placements to meet increased commencements targets (increase form 11 to 16) (New joint provision to be provided in partnership with PACT and EDDAAS. Work towards mainstream provision for DTTO clients with one to one intensive supports through voluntary agency. Prescribing undertake through mainstream provision)

8.1 Meet recurrent costs (plus 2.5% inflationary uplift) of dedicated young peoples treatment service. Fully integrated service provision providing direct access to treatment through self/GP/parent/professional referral. Range of treatment options available full details of which are in the Young People's Substance Misuse Plan (Cost include full running cost for the service ie premises, management, administration) NB Due to increasing numbers of YP accessing service provision the Treatment and YP sub Groups, ratified by the DAT, recognised and agreed the need for financial support for an effective YO Service provision

9.1 Strengthen links with PCT and service providers to ensure robust clinical governance procedures are in place. Through commissioning monitoring processes ensure that all providers have a ‘critical incident’ policy and that procedures are in place to facilitate verification by the Drug Action Team JCG

10.1 Work with the PCT to identify specific funding to enable GP’s to refer to PACT harm minimisation clinic for blood borne virus testing and immunisation 125 client referrals @ £42 per immunisation

10.2 Work with PCT and Health Protection agency to ensure advice and information literature is widely available

11.1 Establish robust links with the Mental Health LIT to identify level of need for dual diagnosis service provision within Drug Action Team area

11.2 As a result of identification of need, develop a joint action plan between the Drug Action Team and the LIT to set priorities for action together with realistic timescales.

December 2003

April 2004

December 2003

March 2005

March 2004

December 2003

April 2004

June 2004

April 2004

December 2004

April 2004

Ongoing

April 2004

June 2004

April 2004

June 2004

April 2004

September 2004

December 2004

Dorset DATs/NTA/ S&E Dorset PCT

S&E Dorset PCT

DHCT/ Dorset DATs

DAT JCO

Social Services

DAT JCO

DAT JCOs

DAT JCO

DAT JCOs

DHCT

Practice supervisor

PCT director of service development

DAT JCO

PCT director of service development

Mental Health LIT

Zero cost

£245,583??

(see Grid 4 for inpatient costs)

Zero cost

Costs as apportioned in this Plan

See Grid 7:7.1

£150,000 (C/F from 2003/04)

£132,225 M/S

£31,775 (PTB)

£5,000 (PTB)

£27,000 PTB 9.6

£17,950 (BSC)

£19,223 (PTB)

£29,212 (BSC)

£14,000 (PTB)

£3,925 (PTB)

£12,000 (PTB)

See Grid 1-8.1

See planning grid 2

£8,000 (PTB)

£6000 (PTB)

£6480 M/S res. Budget

£16,500 M/S

(inc @ 1.2)

£4,125 (PTB)

*9.7

Zero cost

Zero Cost

£21,320 (PTB)

£10,775 (PTB)

£25,000 (PTB)

£10,000 (PTB)

**£30,000 DAT/CAD to offset PTB and retain school drugs advisor +£18 500 BSC (O/W) + £54,481 (PTB)

**Total cost of service £102,981 **

Zero Cost

£5250 M/S(PCT)

£1,000 M/S (PCT)

From within existing resources

Total costs Box 10

£905,324

Box 11a: Quarterly progress report to DAT – Tier 3 Quarter 1 2 3 4 (Please circle appropriate quarter)
Box 11b: Action point	Box 11c Progress to date	Box 11d: Further action

Planning Grid 4: Tier 4 (a) – Residential and inpatient services

Services in this tier are aimed at those individuals with a high level of presenting need. Services in this tier include inpatient drug treatment, including detoxification and residential rehabilitation. Tier 4a services usually require a higher level of motivation and commitment from the substance misuser than for services in lower tiers. Objectives and joint action plans with Supporting People should be included in this Grid.

Box 1: Summary of self assessment – Tier 4(a) Overall assessment GREEN

Access to inpatient and residential treatment is generally good. However, gaps in provision have been identified in relation to limited access to DHCT Flaghead Inpatient Unit due to no priority bed allocation for Poole clients. Waiting times for access to residential treatment is within national guidelines however, there has been an acute problem due to lack of resources to fund the placements needed. Both Social Service and the Drug Action Team have provided additional budget in 2003/04 to meet identified need for the most chaotic clients. Clients are offered a choice of provider although there is still a predominance of provision based on the 12-step abstinence model and it is difficult to refer to an alternative provision.

Clients referred by PACT will have had the benefit of Hep B immunisation and harm minimisation advice although there are still inadequate screening and treatment provisions to meet the needs of clients.

‘Dry’ accommodation is available through supporting people but there is no provision for clients in treatment and this has been identified as a priority area for Poole Addictions Community Team clients who would benefit from a dedicated community detoxification service.

Box 2a: Objectives from 2003/04 – updated and continuing – Tier 4(a)

1 Implement new service specification developed for DHCT Flaghead Unit, which will provide direct access for Poole clients, referred through PACT.

2 Maintain regular contract monitoring and evaluation of residential contracts and ensure thorough aftercare/discharge planning

3 Develop existing arrangements for DTTO placements to meet increased targets

4 Work with YADAS and Children and Families Services to commission effective Tier 4 treatment provision for young people

Box 2b: New objectives for 2004/5 – Tier 4(a)

5 Increase community care residential budget to meet the increased number of referrals to PACT

Ensure appropriate treatment provision for CJIP client’s returning to the community on release from prison and for those targeted under the persistent offender initiative

Box 3: Planned Spend 2003/04 – Tier 4(a)

£165,190 (PTB £24,000)

Box 4: Likely spend 2003/4 – Tier 4(a)

£36,000 PTB, £80,080 F/h £102,300 M/S

£208,300

Box 5: Planned spend 2004/05 – Tier 4(a)

£201,237 m/s

£10,000PTB

TOTAL £211,237

Box 6 No.	Box 7: Actions/Milestones – Tier 4(a)	Box 8: By when	Box 9: By whom	Box 10: Costs
1 2 3 4 5 6	work with DHCT to deliver inpatient detoxification service in line with new service specification Utilise Poole DATs allocation of beds (27%) (number of planned admissions- 42) and establish effective arrangements for commissioning any underused bed space to other DATs with priority to Bournemouth and Dorset clients NB This is the first time Poole will have use of priority bed space and close monitoring will take place during the year to identify an accurate picture of need/capacity to inform future planning. Further develop existing arrangements for planned discharge/aftercare for all PACT clients receiving treatment in the Flaghead Unit 2.1 In addition to routine contract monitoring, obtain additional feedback from service users in relation to service provision and planned discharge. 2.2. Liaise with residential providers to ensure referral back to PACT, whenever appropriate, in relation to unplanned discharges. 3.1Work with National Probation Service and local treatment providers to increase the number of treatment places available and extend the range of treatment options to limit the need for residential placements. 4.1 Work with the new Young People’s commissioning group and Children and Families Services to ensure access to tier 4 treatment for Poole YADAS clients when necessary 5.1 Commission residential placements for Poole Addictions Community Team clients. Funding will provide approximately 10 x 12 week primary placements and 5 x 12 week secondary placements. Need to be assessed under FAC’s criteria within the local definition of critical. 6.1 Work with PACT and the police to commission appropriate residential treatment provision for clients needing further treatment on release form Prison and for clients identified through the Persistent Offender Scheme with chaotic polydrug use	March 2005 April 2004 April 2004 Quarterly reports Quarterly reports Quarterly reports As required As required Ongoing	Pan Dorset JCG DAT JCO DAT JCO DAT JCO DAT JCO DAT JCO YP JCO DAT JCOs DAT JCOs	Zero cost £105,417(M/S) subject to increase to include capital cost zero cost zero cost zero cost See Grid 3 -7.3 To be spot purchased if necessary £95 820 (+£6480 SDC =102,300) £10,,000(PTB) *9.4
Total cost Box 10				£211,237

Box 11a: Quarterly progress report to DAT – Tier 4(a) Quarter 1 2 3 4 (Please circle appropriate quarter)
Box 11b: Action point	Box 11c Progress to date	Box 11d: Further action

Planning grid 5: Workforce development

The required expansion and improvement of the treatment sector cannot be achieved without a significant expansion in the workforce, and a step change in the training and professional development of these employees. DATs and service providers will need to implement local workforce initiatives, in addition to the NTA programme, in order to address local recruitment and training needs.

In terms of workforce plans for 2004/5 DATs should particularly note the requirement that all job descriptions and person specifications for staff working within the drug treatment sector should be revised so that roles are expressed in line with the DANOS competency statements by September 2004.

Box 1: Summary of self-assessment – Workforce Overall Assessment – Green

The Drug Action Team does not have a dedicated recruitment and retention Strategy or a formal training strategy. However, training is a high priority in the local delivery of each area of the National Strategy. Through an amalgamation of funding streams the Drug Action Team has commissioned and expanded drug training across the Borough.

Not all service providers have incorporated DANOS into existing job descriptions as this has been identified as an area for closer scrutiny in terms of changes to existing employee’s contracts of employment. However, all job descriptions are revised in line with DANOS when existing posts are vacated and all new posts have DANOS incorporated.

Box 2a: Objectives from 2003/04 – Updated and continuing - Workforce

1 Through the Drug Action Team and the wider merged CDRP/DAT merged partnership, to encourage all agencies to participate in the Boroughwide drug awareness training

Box 2b: New objectives for 2004/5 – Workforce

Ensure all service providers revise job descriptions in line with DANOS
Recruitment and retention procedures recognise and action the recommendations contained in the NTA Training Needs Analysis
Through regular workforce monitoring, evaluate staffing requirements and the percentage of BME workers employed in local services

Box 3: Planned spend 2003/04 – Workforce

£1,500

Box 4: Likely spend 2003/4 – Workforce

£700

Box 5: Planned spend 2004/05 - Workforce

From within existing resources

Box 6 No.	Box 7: Actions/Milestones - Workforce	Box 8: By when	Box 9: By whom	Box 10: Costs
1 2 3 4	As a result of the DAT Partnership Standard and the new merged partnership self assessment, to ensure that all partners incorporate a commitment to staff training and skills development in their respective business plans All service providers and DATs/CDRP partner agencies provided with the opportunity for staff to attend the free drug awareness training (linked to DANOS competencies) – Stage 1,2 and 3 Using the opportunity afforded by delivering ‘Drug and Alcohol in the Workplace ‘training, encourage employers to facilitate staff training and development and disseminate information to employees on local service provision in relation to services for users, parents, young people and children of substance users. Fund external trainers to attend DANOS training to obtain accreditation to deliver training and assessment in line with DANOS Fund external trainer to attend ‘Drugs in the Workplace’ training (Target – 5 Businesses per year trained) All service providers to revise job descriptions and person specifications in line with DANOS as posts become vacant or with the prior consent of current employees in line with NTA timescales/guidelines Where appropriate, encourage service providers to establish trainee and volunteer development schemes.(Target – one new provider per annum) Work with providers to review staff costs with a view to aligning salaries to comparable services on other voluntary/statutory sector services Work with the NTA to identify ways if implementing the recommendations contained in its Training Needs Analysis, particulalry in relation to recruitment and retention. Ensure providers produce workforce data on a monthly basis to inform service planning and to meet the requirements of the NTA Encourage staff to share information in relation to ethnicity to demonstrate equality of opportunity and to facilitate monitoring of any increase in the number of BME workers	April; 2004 Ongoing Ongoing December 2003 January 2004 Ongoing Ongoing March 2005 Ongoing Monthly Monthly	Merged partnership External training provider External training provider DAT JCO DAT JCOs All providers/monitored by JCO DATC DAT JCO NTA regional reps/DATC DAT JCOs DAT JCO	Zero Cost From within existing resources From within existing resources £200 DATs/CAD 2003 £500 DATs/CAD 2003 Within existing resources Within existing resources Cost to be identified Cost to be identified Zero Cost Zero Cost
Total costs Box 10:				£000

Box 11a: Quarterly progress report to DAT – Workforce Quarter 1 2 3 4 (Please circle appropriate quarter)
Box 11b: Action point	Box 11c Progress to date	Box 11d: Further action

Planning grid 6: Under-served groups

This planning grid focuses on the strategic planning process to develop appropriate services for populations who are not fully represented within drug treatment services.

Box 1: Summary of self-assessment – Under-served groups Overall Assessment - Amber

The Drug Action Team has not commissioned any dedicated work to inform the development of treatment services for BME drug users. However, through work with other agencies, primarily the Dorset Racial Equality Council, it has obtained information on local diversity issues and has developed a mechanism for the sharing and dissemination of information which assists DAT planning. The overall BME population in Poole is very low with Chinese being the largest minority group in Poole. Recent research highlighted that language and unfamiliarity with local service provision was an issue and the DAT has subsequently produced a range of advice and information in three minority ethnic languages and has facilitated access to language line for clients accessing services. Working with a local faith group has identified the need for access to services for the homeless and rough sleepers and a pilot project is underway to address identified problems. Services in contact with Travellers (who form a significant minority group at certain times of the year) need to ensure they provide information and advice on available local services. Dedicated service provision is available for stimulant users and women

Box 2a: Objectives from 2003/04 – updated and continuing – Under-served groups

1 Increase the number of gay, lesbian, bi-sexual and trans gender people accessing service provision

2Continue to provide dedicated stimulant and women’s clinics through PACT

3Through QuADS and regular contract monitoring, ensure that all providers adhere to the race Relations Act

4 Ensure that agencies working with Travellers have training in drug awareness and are able to provide information on, or refer to, appropriate service provisions

Box 2b: New objectives for 2004/05 – Under-served groups

Provide dedicated Crack training for all PACT staff
Work with local faith group to address the need of homeless/rough sleepers

Box 3: Planned spend 2003/04

£2,500

Box 4: Likely spend 2003/4

£3,500

Box 5: Planned spend 2004/05

£8,790 (PTB)

Box 6 No.	Box 7: Actions/Milestones – Under-served groups	Box 8: By when	Box 9: By whom	Box 10: Costs
1 2 3 4 5 6	1.1Continue to work with LAGLO (lesbian and gay liaison officer) to ensure information on service provisions is widely available 1.2A survey of users of Over the Rainbow (a support organisation for the gay community) identified the need for a dedicated drug/alcohol worker to meet the needs of clients who would not access existing services. Support has been sought from the three Dorset DATs for a jointly funded post to meet the identified needs. (E Grade Nurse or suitably qualified Social worker) 2.1 Provide weekly ‘ women only’ clinic ( with childcare provision if required) and provide dedicated women only complimentary therapy sessions with crèche facility (8 treatment places per week) 2.2 Provide weekly stimulant clinic and a range of complimentary therapies for clients 2.3 Liaise with the local GUM clinic to provide a dedicated weekly session in when PACT operate from new premises 3 .1 Monitor data from service providers to establish whether the level of clients by ethnicity remains consistent with local statistical and health ethnicity data. All contracts/SLA’s commissioned by the DAT require service providers to comply with the Race Relations Act and include specific procedures in relation to Equal Opportunities (non-discriminatory practice). Providers are required to provide ethnicity Drug Action Team to the DAT Joint Commissioning Officer on a quarterly basis In the non-pejorative sense of the word, providers are required to recognise that it is essential to discriminate between different client groups to ensure that there needs are met, but this discrimination must not be discriminatory. 4.1 Liaise with local agencies and services working with Travellers to ensure that staff have accessed the Borough wide drug awareness training and are able to supply literature, advice and information on referral routes to services. 4.2 Ensure that up to date information and advice on drug relates issues and local service provision is available in the three main ethnic languages 5.1Commission dedicated training on ‘Crack Cocaine’ for all members of Poole Addictions Community Team (18 places available) 5.2Provide one training place for external trainer to facilitate the cascading of Crack training to other providers 6.1 Work with local faith group to develop a pilot project providing outreach services to homeless/ rough sleepers with drug and/or alcohol problems and extend drop in facility to include weekend session. ( See Grid 2 –8.1) 6.2Work with the PCT to identify a GP willing to work with PACT to enable clients to register and enable appropriate prescribing to take place. (NB this is also a problem for many prisoners returning to the community who have no accommodation or GP)	Ongoing June 2004 Weekly Weekly June 2004 Quarterly Quarterly Quarterly Ongoing Ongoing December 2003 December 2003 See Grid 2 September 2003	PACT Harm minimisation nurse Pan Dorset JCG PACT PACT PACT DAT JCO DAT JCO DAT JCOs Drug Action Team Co-ordinator DAT JCO DAT JCO DAT JCOs See Grid 2 PCT Director of Service development	Zero Cost Total cost £27,000 x York formula = £4860 or East Dorset formula = £7290 (PTB) 9.8 See Grid 3 See Grid 3 Zero Cost Zero Cost Zero Cost Zero Cost Zero Cost £1,500 (PTB) 9.9 £1000 (DAT/CAD 2003) zero cost See Grid 2 Zero Cost

Total £8790

Box 11a: Quarterly progress report to DAT – Under-served groups Quarter 1 2 3 4 (Please circle appropriate quarter)
Box 11b: Action point	Box 11c Progress to date	Box 11d: Further action

Planning grid 7: Systems and infrastructure

This planning grid should include objectives and action plans in relation to:

Models of care implementation and development

Joint initiatives across DAT partners

Commissioning, financial, performance management and information activities to support delivery of the treatment plan

Consultation and publication arrangements

Box 1: Summary of self-assessment – Systems and infrastructure Overall Assessment - Green

In the interest of service providers that work across more than one DAT area, it was agreed that Models of Care would be implemented on a pan Dorset basis. This has resulted in some deadlines not being met although work has started on all target areas. The management of waiting times is broadly within National Targets although fluctuation in staffing levels can have a negative effect. Developments are in progress to ensure that integrated service delivery in relation to the CJS will expand and continue to provide a robust and effective service. Links between the DATs and the Mental Health LIT have been established and work is planned to more fully identify local need and establish a local Dual Diagnosis provision.

Fully developed commissioning arrangements are in place although the DAT has not yet reached agreement with all commissioners to enable full commissioning of all mainstream spend.

Consistent information gathering in electronic format from all providers is an area requiring development and investment. In conjunction with MoC implementation, new systems are being developed to address the data collection requirements on DATs from the NTA, Home Office, DoH, SHA’s and other government agencies in relation to BVPI’s, KPI’s and LPSA targets.

Through existing mechanisms, consultation takes place throughout the year in relation to treatment planning and service delivery.

Box 2a: Objectives from 2003/04 – updated and continuing – Systems and infrastructure

1In conjunction with Dorset and Bournemouth DATs, review the existing mechanism for the delivery of MoC and amend as necessary.

2Retain DAT Joint Commissioning Officer in post and maintain effective commissioning arrangements

Box 2b: New objectives for 2004/5 – Systems and infrastructure

Work with PACT and NIMHE to develop a service improvement tool to assist with achieving a reduction in waiting times between modalities

Through the Pan Dorset Criminal Justice steering Group ensure an integrated and consistent CPA within partner agencies in relation to people in the CJS

Develop mechanism for receiving information from the local coroners office in relation to drug related deaths

Establish new working arrangements and links with the Mental Health LIT

Develop and implement a new electronic data collection system for providers located in the DAT area

Work with the newly established carers forum to establish an effective consultation mechanism

Box 3: Planned spend 2003/04

£29,970moc,£34,750

Box 4: Likely spend 2003/04

£33,000, £17,500moc

Box 5: Planned spend 2004/05

£400 m/s

£86,844 Pooled Treatment Budget

TOTAL £87,244

Box 6:

Box 7: Actions/Milestones – Systems and infrastructure

Box 8:

By when

Box 9: By whom

Box 10:

Costs

As a result of difficulties in co-ordinating MoC implementation across three Drug Action Team areas, undertake a review of work to date and develop a revised timetable for implementation which clearly identifies areas to be prioritised in order to meet future deadlines

Circulate draft screening, referral and assessment arrangements for final agreement. Report response to Treatment Sub Group as lead for MoC and work to finalise/implement agreed arrangements by September 2004

Finalise the review of existing information protocols and develop new document to be agreed by all agencies (Link with IRT in relation to young people’s information sharing protocol)

Publish revised service directory to include referral routes and circulate widely to service users and providers

Implement interim care co-ordination arrangements pending the identification of resources to develop a more robust system (See Grid 2-7.1)

Continue to fund a pan Dorset post to lead on MoC implementation

In conjunction with Dorset and Bournemouth DATs, develop a dedicated MoC training programme for workers at all tiers. Staged delivery during 2004

2.1 Joint Commissioning Officer retained in post and Service Specifications

completed for all services commissioned. (DHCT Service Specifications still to

be agreed with the Trust)

2.2 Data collection and monitoring system and monitoring system (financial and

statistical) to be reviewed in order to best meet emerging requirements for

government returns and future treatment planning

2.3 Establish p/t information/administration officer to increase capacity of Drug Action

Team Co-ordinator/Joint Commissioning Officer and to be responsible for

information sharing within the integrated DAT/CDRP partnership (Gen 3 Post)

2.4 Robust commissioning arrangements maintained with the full participation of all

partners to ensure target setting and the delivery of services in line with national

and local standards

2.5 Continue to fund Quads through the SW Peer Audit project for a further year but

investigate alternative providers for future years

Work with providers to implement any recommendations made by the SW Peer

Audit Project

3.1 Local service providers to meet to implement service improvement tool to

develop local arrangements for reducing waiting times and improving access to

all modalities for PACT clients

4.1 Work through the pan Dorset CJ steering Group to identify needs and gaps in

provision in relation to an integrated and consistent system to get drug

misusing offenders into treatment, throughcare and aftercare (See Grid 2-6.2

and Grid 3 - 4.8 & 6.2)

5.1 Enter into local arrangement with Coroners office for the supply of copies of all

drug related death reports relevant to the Drug Action Team area. This will inform

action planning for reducing drug related deaths

Work with the Mental Health LIT to implement the detailed DHCT Action Plan at a local level. (There is no clear evidence of the gap between service provision and need and improved joint working and commissioning is needed to ensure a co-ordinated approach)

A draft report outlining priorities has been prepared and will be submitted to the Drug Action Team and the LIT as a basis for a programme of work to identify need and establish a service provision for Dual Diagnosis

7.1 Work with Bournemouth and Dorset DATs to develop and implement an

electronic system of data collection for use by all providers which will inform future

service planning and provide data for submission as required by the Drug Action

Team.

7.2 Work with providers to ensure that appropriate staff are trained and supported in

the use of new data collection tools and that information (which meets minimum

data set/NDTMS requirements) is passed electronically to the Joint

Commission Officer on a monthly basis

Continue to support the new Poole SURF (service users) and facilitate involvement in all planning processes.

Continue to work with existing provider and Social Services to develop pilot Poole Carer Forum project to include carer representation within the DAT structure and an effective consultation mechanism

February 2004

March 2004

April 2004

April – October 2004

Ongoing

By April 2004

June 2004

Quarterly meetings

December 2004

ongoing

January 2004

Quarterly meetings

Ongoing

January 2003

April 2004

April 2004 – March 2005

April 2004/monthly

Ongoing

June 2004

Pan Dorset JCG

MoC lead

DAT JCOs

PACT Practice supervisor

DAT JCO

MoC lead

DAT JCO

Drug Action Team Co-ordinator

DAT JCO

Drug Action Team Co-ordinator

DATC/LIT Lead

Pan Dorset JCG

DAT JCOs

DATC

Clouds

Zero cost

From within existing resources

£8,000 PTB *9.10

Interim zero cost

£15,000 (PTB)

*9.11

£10,000 (PTB) york formula =

£1,800 (PTB)

£30,800 (PTB)

Zero Cost

£17,200 pro rata (to include recruitment costs) 9.12

(PTB)

Zero Cost

£3,044(PTB)*9.13

Zero Cost

See Grids 2 &3

Zero Cost

£10,000 (PTB)

*9.14

from within existing resources

£500 (PTB)

£400 M/S

TOTAL £87,244

Box 11a: Quarterly progress report to DAT – Systems and infrastructure Quarter 1 2 3 4 (Please circle appropriate quarter)
Box 11b: Action point	Box 11c Progress to date	Box 11d: Further action

Planning grid 8: Users and carers

Box 1: Summary of self-assessment – Users and carers overall assessment – Amber

Both user and carer involvement with the Drug Action Team area is in its very early stages. During the past year groups have been established but neither group has yet established a robust mechanism to support full participation in Drug Action Team structures. The new merged CDRP/DAT partnership has also identified areas of concern by some partners in relation to service user representation within the new structure in relation to some Criminal Justice issues.

Financial support from within limited DAT resources does not provide sufficient funding to meet the identified need of both groups although the Drug Action Team makes every effort to provide ‘in kind’ support ie training, room hire, stationary

Box 2a: Objectives from 2003/04 – Updated and continuing – Users and carers

1 Contractual arrangements continue to include monitoring of service user feedback

Continue to work with Clouds families Plus to promote and extend the pilot carers project

Formalise arrangements for remuneration for involvement in Drug Action Team activities

Continue both financially and through ‘in kind’ support to facilitate the Service User Forum

Box 2b: New objectives for 2004/5 – Users and carers

5 Work with service users and carers to establish meaningful involvement in all Drug Action Team activities

6 Request the NTA to provide regional fora for groups to meet and share best practice, advice and information and to receive training on topics relevant to Drug Action Teams

Box 3: Planned spend 2003/04

£500

Box 4: Likely spend 2003/04

£700

Box 5: Planned spend 2004/05

Box 6 No.	Box 7: Actions/Milestones – Users and carers	Box 8: By When	Box 9: By Whom	Box 10: Costs
1 2 3 4 5 6	1.1 All new and existing contracts to specify that evaluation of services by users will be monitored by the Joint Commissioning Officer and the outcomes taken into account in the development of future service provision 1.2 Continue to obtain the views of PACT clients on all areas of local service provision on a regular basis (Positive feed back regularly received and reported to Treatment Sub group – areas of concern relate to PACT accommodation) 2.1 Pilot carer project established and extended. ( Pump priming funding from Social Services Carer Budget and free use of premises secured. Service commissioned at reduced cost.) Continue to promote group on local radio and through advertising in public areas. 2.2 identify alternative accommodation for project and zero cost 2.3 Encourage and facilitate a diverse range of consultation processes with Carers through the group 3.1 The Drug Action Team to agree and formalise arrangements for remuneration paid to service users/cares attending DAT activities. (Out of pocket expenses currently paid) Provide office accommodation and ancillary equipment on one afternoon per week (PACT accommodation) for Service User Group Continue to provide stationary etc for service user Group Facilitate access to ‘free’ training for service user representatives in relation to Drug Action Team business and other courses ie developing IT skills Work with other Drug Action Teams and the NTA to develop a support network for SU groups in the South West Work with SU group to formulate advocacy/support role for Poole Addictions Community Team clients as part of the care co-ordination for MoC and identify funding implications 5.1 Engage with Service users and carers to seek their views on an effective mechanism for consultation and meaningful involvement in Drug Action Team activities and implement changes accordingly Identify a range of different mechanisms through consultation with other SW region DATs and established SU Fora. 6.1 Work with the NTA regional deputy managers to establish a mechanism for SW regional fora to support new and established service user and carer groups and to investigate the possibility of regional training events	Quarterly Quarterly Ongoing Ongoing Ongoing February 2004 Weekly Ongoing Ongoing June 2004 September 2004 Ongoing April 2004 June 2004	DAT JCO DAT JCO DAT JCOs DAT JCO/Clouds DAT JCO/Clouds Drug Action Team Co-ordinator DAT JCO DAT JCO DAT JCO DATJCO All providers reporting to the JCO GO DT advisors NTA regional JCO	Zero Cost Zero Cost See Grid 7-8.2 Zero Cost Zero Cost See grid 7 8.2 From within existing resources From within existing resource Zero ost Zero Cost Zero Cost From within existing NTA resources
Total costs Box 10:				£000

Box 11a: Quarterly progress report to DAT – Users and carers Quarter 1 2 3 4 (Please circle appropriate quarter)
Box 11b: Action point	Box 11c Progress to date	Box 11d: Further action

Planning grid 9: Tier 1 – 4 Priorities for inclusion – subject to the identification of funds

Box 1: Although it is accepted that by the date of final submission, the DAT may be more able to accurately predict available resources for 2004/05 (ie slippage), at the time of drafting the Treatment Plan there are significant concerns regarding its ability to deliver effective services across all tiers from within identified resources.

There are two main areas of concern:

The allocation of a zero growth Poole Treatment Budget; and

The unresolved identification of mainstream spend in relation to service delivery by Dorset Healthcare NHS Trust.

Despite protracted discussions during the past eighteen months between the three Dorset Drug Action Teams and the lead commissioners for substance misuse and intervention and assistance from the National Treatment Agency, limited progress has been made to facilitate commissioning of all mainstream services by the Drug Action Team.

The majority of treatment provision in Poole is dependent on adequately staffed services. A zero growth budget has obviously resulted in difficulties in maintaining current staffing levels due to the need to fund inflationary and incremental salary increases. (Recruitment and retention problems within the DAT area have already been identified as a problem). Additional burdens on limited resources have resulted as a consequence of the development and expansion of services in line with Government and National Treatment Agency requirement ie Models of Care, new data collection requirements requiring investment in IT, improved blood borne virus services and developing service capacity to meet targets for increasing the number of people entering treatment.

The financial difficulties are further compounded by the unresolved mainstream funding issues. Funding is allocated to Dorset Healthcare Trust (which is commissioned by the South and East Dorset PCT as lead commissioner for substance misuse in Dorset) to provide an effective addiction service for Poole. It has been agreed that Poole Drug Action Team should receive an allocation of 27% of the total cost of the DHCT Addiction service. However, by examining planning grids 1-9 of this plan it can be seen that neither proportionate funding or staffing levels are allocated by DHCT to provide an effective service provision for Poole residents. In order to meet national directives and, more importantly, the needs of Poole clients a significant proportion of the Pooled Treatment Budget is allocated to ensure an effective local service.

Whilst it is recognised that a number of funding streams, including new CJIP Finance, have a positive impact on service provision these resources are restricted for "spend" in specific areas and cannot be diverted to meet unmet need generally in relation to service development identified as a priority in Poole. The Drug Action Team has therefore recommended the inclusion of an additional planning grid which identifies the priorities which the DAT is unlikely to be in a position to deliver during the coming financial year until the outstanding mainstream funding issue has been resolved. It must be noted that this may result in cuts in service provision or inadequate development of new provision.

Box 3: Planned spend 2003/04

Box 4: Likely spend 2003/04

Box 5: Planned spend 2004/05

£149,404

Box 6: No

Box 7: Actions/Milestones – Tier 1

Box 8: By when

Box 9: By whom

Box 10: Costs

9.1

Grid 1

9.2

Grid 2

9.3

Grid 2

9.4

Grid 4

9.5

Grid 2

9.6

Grid 3

9.7

Grid 3

9.8

Grid 6

9.9

Grid 6

9.10

Grid 7

9.11

Grid 7

9.12

Grid 7

9.13

Grid 7

9.14

Grid 7

8.1Agree a new and comprehensive pharmacy training programme to I

include basic drug awareness, screening and assessment, harm

minimisation information etc

Meet recurrent costs of Hepatitis B immunisations and blood testing for PACT clients (360 new clients per annum @£42 per vaccine)

4.1 Continue to provide advice and information literature promoting

local service provision, including revised service directory, to

professionals, service users and the wider public

6.1Meet the cost of residential placements for CJIP clients

7.1 To work with Bournemouth and Dorset DATs and service providers

to develop effective care co-ordination in line with models of care.

As an interim measure agencies will be required to provide ‘in

house’ care co-ordination which may lead to a reduction in service

provision due to new service delivery from within existing

resources.

The DATs will seek funding to develop a dedicated

care co ordination service for clients whose needs cross several

areas and who require co-ordination of care on behalf of each of

the services and agencies involved It is estimated that each

worker could case carry 25 clients and that a minimum of three

workers (suitably trained) would be required to meet the needs of

Poole Addictions Community Team clients with complex needs

Establish new F grade nursing post within Poole Addictions Community Team to provide support for community detoxification Clinical Governance provided by PACT G Grade nurse. Target 30 detox per year.

Meet the recurrent cost of the p/t G grade pharmacy liaison post (plus 2.5% inflationary uplift). This post to work with GP’s to engage with and provide support within GP Practices in relation to Shared Care arrangements NB This post is funded until December 2004 from the reinstated community detoxification funding for 2004/04 (£18,360)

1.2A survey of users of Over the Rainbow (a support organisation for the gay community) identified the need for a dedicated drug/alcohol worker to meet the needs of clients who would not access existing services. Support has been sought from the three Dorset DATs for a jointly funded post to meet the identified needs. (E Grade Nurse or suitably qualified Social worker)

4.2 Ensure that up to date information and advice on drug relates issues and local service provision is available in the three main ethnic languages

1.4 Publish revised service directory to include referral routes and circulate widely to service users and providers

Continue to fund a pan Dorset post to lead on MoC implementation

Establish p/t information/administration officer to increase capacity of Drug Action Team Co-ordinator/Joint Commissioning Officer and to be responsible for information sharing within the integrated DAT/CDRP partnership (Gen 3 Post)

Continue to fund Quads through the SW Peer Audit project for a further year but investigate alternative providers for future years

7.1 Work with Bournemouth and Dorset DATs to develop and

implement an electronic system of data collection for use by all

providers which will inform future service planning and provide

data for submission as required by the Drug Action Team.

Ongoing through 2004/05

April 2004

Ongoing

April 2004

October 2004

June 2004

December 2004

June 2004

Ongoing

April 2004

June 2004

April 2004

April 2004-March 2005

PCT pharmaceutical advisor/PACT GP liaison nurse

DAT JCO

Drug Action Team Co-ordinator

DAT JCO

DAT JCOs

Pan Dorset JCG

DAT JCOs

DAT JCO

Drug Action Team Co-ordinator

DAT JCOs

Pan Dorset JCG

£2000 PTB

£15,120 PTB

£2,500 PTB

£10,000 PTB

3 X £17,750 per annum = half year cost of

£26,625 (PTB)

£27,000 (PTB)

£4,125 (PTB)

Total cost £27,000 x York formula = £4860 or East Dorset formula = £7290 (PTB)

£1500 (PTB)

£8 000 (PTB)

£15 000 (PTB)

£17,200 pro rata (to include recruitment costs)

£3,044 (PTB)

£10,000 (PTB)

Total cost Box 10:

£149,404

Grid costings

	Social services	police	BSC	Health m/s	Pooled Treatment Budget	total
Grid 1		1,500			4000	5,500
Grid 2	47,641	9,540	31,857 ars 70,826 cjip	8,700	159,794	328,358
Grid 3	138,705		95,662 BSC dat/cad	268,333	252,624	755,324 + 150,000 c/f 905,324
Grid 4	95,820			105,417	10,000	211,237
Grid 5						-
Grid 6					8,790	8,790
Grid 7	400				86,844	87,244
Grid 8
TOTAL	282,566	11,040	198,345	382,450	522,052	1,546,453
Grid 9 (priority spend to be deducted)					149,404	149,404
SubTotal						£1,397,049
Unallocated PTB						37,352
TOTAL SPEND FOR 04/05						£1,434,401
Total PTB spend					372,648
Priorities to be agreed for reinstatement to the value of:					37,352

NB The figures shown in blue and marked ‘2003’ in Grids 1-8 show new ‘in year’ projects not included in the 2003 Treatment Plan which have been funded in 2003/04 and therefore not included in the spend for 2004/05 as set out in this Plan. They have been included to provide a clear indication of services in place/[planned for this financial year.